IMPACT OF THE IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR ON REHOSPITALIZATIONS

Patients who survive out-of-hospital ventricular tachycardia or ventri cular fibrillation are at risk of sudden cardiac death and often retur n to hospital after initial discharge. The frequency and duration of r eadmittance to hospital are not well known. Thus, the purpose of this study was to evaluate the impact of the implantable cardioverter defib rillator on frequency and duration of hospitalizations. Methods Betwee n 1989 and 1993, 38 consecutive patients who had drug-refractory ventr icular tachyarrhythmias were selected for the study. A total of 38 pat ients were implanted with the implantable cardioverter-defibrillator i n accordance with the guidelines of the European Society of Cardiology . This analysis includes 35 of the 38 patients (92%). All hospitalizat ions which occurred one year before and one year after were studied. C linical information for all patients was obtained by consulting medica l records and by interviewing personal general practitioners. Results The annual number of hospitalizations before and after implantation of the implantable cardioverter-defibrillator was, respectively, 3 . 28/-2 . 38 hospitalizations/patient/year and 0 . 88+/-1 . 23 hospitaliza tions/patient/year (P<0 . 05). Before implantation of the implantable cardioverter-defibrillator, patients were hospitalized a mean of 32 . 94+/-24 . 18 days/patient/year and after, 9 . 31+/-32 . 14 days/patien t/year (P<0 . 05). The number of hospitalizations for cardiac reasons decreased by 90%. Before implantation, the most frequent cause was ven tricular tachyarrhythmia (47 hospitalizations for ventricular tachycar dia and eight for ventricular fibrillation), while after implantation, it was as a result of the shock from the implantable cardioverter-def ibrillator (11 hospitalizations). The number of hospitalizations for n on-cardiac reasons were similar in the two time periods. Of the 35 pat ients, 26 (74%) had at least one appropriate successful ventricular ta chycardia interrupted by the implantable cardioverter-defibrillator, w hile 17 patients (49%) had their ventricular fibrillation terminated. There is a significant difference in the rate of hospitalizations to i ntensive care units (ICU) between the two periods. Before implantation , 30% of hospital days were spent in the ICU, with 3% after. Conclusio ns This study documents that the implantable cardioverter-defibrillato r not only reduces the frequency and duration of hospital stays, but r educes admissions to the more expensive units in hospital. Taking into account the reduction in hospitalizations, the payback period for the implantation of an implantable cardioverter-defibrillator is 19 month s.